Abstract
Psychosocial factors are influential in an athlete’s decision and readiness to return to sport after anterior cruciate ligament reconstruction. These factors encompass cognitive (expectation, motivation, self-efficacy), emotional (mood and anxiety, fear of movement, or reinjury), and behavioral (rehabilitation adherence) domains and can directly impact postoperative recovery. Screening for psychosocial factors with the use of validated measures may assist in the identification of athletes at risk for not returning to their preinjury level of sport participation. When indicated, the inclusion of psychosocial management strategies could enhance recovery toward return to sport.
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References
Ardern CL, Taylor NF, Feller JA, Webster KE, et al. Br J Sports Med. 2013;47(17):1120–6.
Ardern CL. Anterior cruciate ligament reconstruction-not exactly a one-way ticket Back to the Preinjury level: a review of contextual factors affecting return to sport after surgery. Sports Health. 2015;7(3):224–30.
Czuppon S, Racette BA, Klein SE, Harris-Hayes M. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med. 2014;48(5):356–64.
Walker N, Thatcher J, Lavallee D. Psychological responses to injury in competitive sport: a critical review. J R Soc Promot Heal. 2007;127(4):174–80.
Morrey MA, Stuart MJ, Smith AM, Wiese-Bjornstal DM. A longitudinal examination of athletes’ emotional and cognitive responses to anterior cruciate ligament injury. Clin J Sport Med. 1999;9(2):63–9.
Tracey J. The emotional response to the injury and rehabilitation process. J Appl Sport Psychol. 2003;15(4):279–93.
Crossman J. Psychological rehabilitation from sports injuries. Sports Med. 1997;23(5):333–9.
Chmielewski TL, Zeppieri G Jr, Lentz TA, Tillman SM, Moser MW, Indelicato PA, et al. Longitudinal changes in psychosocial factors and their association with knee pain and function after anterior cruciate ligament reconstruction. Phys Ther. 2011;91(9):1355–66.
Brewer BW, Cornelius AE, Sklar JH, Van Raalte JL, Tennen H, Armeli S, et al. Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: a daily process analysis. Scand J Med Sci Sports. 2007;17(5):520–9.
Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med. 2009;43(5):377–81.
Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596–606.
Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.
Podlog L, Eklund RC. The psychosocial aspects of a return to sport following serious injury: a review of the literature from a self-determination perspective. Psychol Sport Exerc. 2007;8(4):535–66.
Wiese-Bjornstal DM, Smith AM, Shaffer SM, Morrey MA. An integrated model of response to sport injury: psychological and sociological dynamics. J Appl Sport Psychol. 1998;10(1):46–69.
Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 consensus statement on return to sport from the first world congress in sports physical therapy, Bern. Br J Sports Med. 2016;50(14):853–64.
Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med. 2004;34(4):269–80.
Ardern CL, Kvist J, Webster KE. Psychological aspects of anterior cruciate ligament injuries. Oper Tech Sports Med. 2016;24(1):77–83.
Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS. Decision to return to sport after anterior cruciate ligament reconstruction, part I: a qualitative investigation of psychosocial factors. J Athl Train. 2018;53(5):452–63.
Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752–62.
Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549–58.
Sonesson S, Kvist J, Ardern C, Osterberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1375–84.
Feucht MJ, Cotic M, Saier T, Minzlaff P, Plath JE, Imhoff AB, et al. Patient expectations of primary and revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):201–7.
McVeigh F, Pack SM. An exploration of sports rehabilitators’ and athletic rehabilitation therapists’ views on fear of reinjury after anterior cruciate ligament reconstruction. J Sport Rehabil. 2015;24(2):140–50.
Scott SM, Perry MA, Sole G. “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. Disabil Rehabil. 2018;40(19):2311–7.
Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports. 2008;18(3):325–35.
Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):1021–8.
Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):9–15.
Smith AM, Scott SG, Ofallon WM, Young ML. Emotional responses of athletes to injury. Mayo Clin Proc. 1990;65(1):38–50.
Thomee P, Wahrborg P, Borjesson M, Thomee R, Eriksson BI, Karlsson J. A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury. Scand J Med Sci Sports. 2006;16(3):181–7.
Waldrop D, Lightsey OR, Ethington CA, Woemmel CA, Coke AL. Self-efficacy, optimism, health competence, and recovery from orthopedic surgery. J Couns Psychol. 2001;48(2):233–8.
Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005;117(1–2):137–44.
Kori SH, Miller RP, Todd DD. Kinesiophobia: a new region of chronic pain behavior. Pain Manag. 1990;3:35–43.
Faltstrom A, Hagglund M, Kvist J. Factors associated with playing football after anterior cruciate ligament reconstruction in female football players. Scand J Med Sci Sports. 2016;26(11):1343–52.
Brewer BW, Van Raalte JL, Cornelius AE, Petitpas AJ, Sklar JH, Pohlman MH, et al. Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction. Rehabil Psychol. 2000;45(1):20–37.
DiSanti J, Lisee C, Erickson K, Bell D, Shingles M, Kuenze C. Perceptions of rehabilitation and return to sport among high school athletes with ACL reconstruction: a qualitative research study. J Orthop Sports Phys Ther. 2018;48(12):951–9.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.
Thomee P, Wahrborg P, Borjesson M, Thomee R, Eriksson BI, Karlsson J. Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):118–27.
Hamrin Senorski E, Samuelsson K, Thomee C, Beischer S, Karlsson J, Thomee R. Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1364–74.
Chmielewski TL, George SZ. Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2019;27(2):397–404.
Wu HH, Liu M, Dines JS, Kelly JD, Garcia GH. Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction. World J Orthop. 2016;7(11):709–17.
Garcia GH, Wu HH, Park MJ, Tjoumakaris FP, Tucker BS, Kelly JD, et al. Depression symptomatology and anterior cruciate ligament injury: incidence and effect on functional outcome--a prospective cohort study. Am J Sports Med. 2016;44(3):572–9.
Tripp DA, Stanish W, Ebel-Lam A, Brewer BW, Birchard J. Fear of reinjury, negative affect, and catastrophizing predicting return to sport in recreational athletes with anterior cruciate ligament injuries at 1 year postsurgery. Rehabil Psychol. 2007;52(1):74–81.
Podlog L, Dimmock J, Miller J. A review of return to sport concerns following injury rehabilitation: practitioner strategies for enhancing recovery outcomes. Phys Ther Sport. 2011;12(1):36–42.
Johnson U, Ivarsson A, Karlsson J, Hagglund M, Walden M, Borjesson M. Rehabilitation after first-time anterior cruciate ligament injury and reconstruction in female football players: a study of resilience factors. BMC Sports Sci Med Rehabil. 2016;8:20.
Johnston LH, Carroll D. The provision of social support to injured athletes: a qualitative analysis. J Sport Rehabil. 1998;7(4):267–84.
Flanigan DC, Everhart JS, Pedroza A, Smith T, Kaeding CC. Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthroscopy. 2013;29(8):1322–9.
McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD, et al. Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med. 2012;40(11):2523–9.
Ardern CL, Osterberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48(22):1613–9.
Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ. A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med. 2014;42(2):336–42.
Ardern CL, Taylor NF, Feller JA, Webster KE. Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J Sci Med Sport. 2012;15(6):488–95.
Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13(5):393–7.
Chmielewski TL, Jones D, Day T, Tillman SM, Lentz TA, George SZ. The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J Orthop Sports Phys Ther. 2008;38(12):746–53.
Lentz TA, Zeppieri G Jr, George SZ, Tillman SM, Moser MW, Farmer KW, et al. Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. Am J Sports Med. 2015;43(2):345–53.
Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-reported fear predicts functional performance and second ACL injury after ACL reconstruction and return to sport: a pilot study. Sports Health. 2018;10(3):228–33.
Podlog L, Banham SM, Wadey R, Hannon JC. Psychological readiness to return to competitive sport following injury: a qualitative study. Sport Psychol. 2015;29(1):1–14.
Rosso F, Bonasia DE, Cottino U, Cambursano S, Dettoni F, Rossi R. Factors affecting subjective and objective outcomes and return to play in anterior cruciate ligament reconstruction: a retrospective cohort study. Joints. 2018;6(1):23–32.
Han F, Banerjee A, Shen L, Krishna L. Increased compliance with supervised rehabilitation improves functional outcome and return to sport after anterior cruciate ligament reconstruction in recreational athletes. Orthop J Sports Med. 2015;3(12):2325967115620770.
Brewer BW, Cornelius AE, Van Raalte JL, Tennen H, Armeli S. Predictors of adherence to home rehabilitation exercises following anterior cruciate ligament reconstruction. Rehabil Psychol. 2013;58(1):64–72.
Niven A. Rehabilitation adherence in sport injury: sport physiotherapists’ perceptions. J Sport Rehabil. 2007;16(2):93–110.
Niven A, Nevill A, Sayers F, Cullen M. Predictors of rehabilitation intention and behavior following anterior cruciate ligament surgery: an application of the theory of planned behavior. Scand J Med Sci Sports. 2012;22(3):316–22.
Brewer BW, Cornelius AE, Van Raalte JL, Petitpas AJ, Sklar JH, Pohlman MH, et al. Age-related differences in predictors of adherence to rehabilitation after anterior cruciate ligament reconstruction. J Athl Train. 2003;38(2):158–62.
Chan DK, Lonsdale C, Ho PY, Yung PS, Chan KM. Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists’ autonomy-supportive behaviors. Arch Phys Med Rehabil. 2009;90(12):1977–82.
Lentz TA, Paterno MV, Riboh JC. So you think you can return to sport? Br J Sports Med. 2018;52(23):1482–3.
Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step back to move forward. Sports Med. 2017;47(8):1487–500.
de Mille P, Osmak J. Performance: bridging the gap after ACL surgery. Curr Rev Musculoskelet Med. 2017;10(3):297–306.
Ardern CL, Kvist J. What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction? Curr Orthop Pract. 2016;27(3):263–8.
Coronado RA, Bird ML, Van Hoy EE, Huston LJ, Spindler KP, Archer KR. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review. Clin Rehabil. 2018;32(3):287–98.
Cupal DD, Brewer BW. Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabil Psychol. 2001;46(1):28–43.
Maddison R, Prapavessis H, Clatworthy M, Hall C, Foley L, Harper T, et al. Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. Scand J Med Sci Sports. 2012;22(6):816–21.
Maddison R, Prapavessis H, Clatworthy M. Modeling and rehabilitation following anterior cruciate ligament reconstruction. Ann Behav Med. 2006;31(1):89–98.
Zaffagnini S, Russo RL, Marcheggiani Muccioli GM, Marcacci M. The Videoinsight(R) method: improving rehabilitation following anterior cruciate ligament reconstruction--a preliminary study. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):851–8.
Rock JA, Jones MV. A preliminary investigation into the use of counseling skills in support of rehabilitation from sport injury. J Sport Rehabil. 2002;11(4):284–304.
McArdle S. Psychological rehabilitation from anterior cruciate ligament-medial collateral ligament reconstructive surgery: a case study. Sports Health. 2010;2(1):73–7.
Mahoney J, Hanrahan S. A brief educational intervention using acceptance and commitment therapy: four injured athletes’ experiences. J Clin Sport Psychol. 2011;5:252–73.
Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.
Brewer BW. Self-identity and specific vulnerability to depressed mood. J Pers. 1993;61(3):343–64.
Sordoni C, Hall C, Forwell L. The use of imagery by athletes during injury rehabilitation. J Sport Rehabil. 2000;9(4):329–38.
Meierbachtol A, Yungtum W, Paur E, Bottoms J, Chmielewski TL. Psychological and functional readiness for sport following advanced group training in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2018;48(11):864–72.
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Coronado, R.A., Herzberg, S., Archer, K.R. (2019). Identification and Management of Psychosocial Issues in the Athlete for Return to Sport. In: Noyes, F., Barber-Westin, S. (eds) Return to Sport after ACL Reconstruction and Other Knee Operations. Springer, Cham. https://doi.org/10.1007/978-3-030-22361-8_24
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